BLD2008-0117 LEGAL DOCS07/01/2006 09:35 18005211528 INSURANCETEK PAGE 01/01
DATE JMMIDDrY-M)
ACO&P, CERTIFICATE OF LIABILITY INSURANCE —77/1/2008
PRODUCER (425)357-1555 FAX (425)357-1551 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
IneuranceTek Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CA Licence #OE32789 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
13300 Bothell-Evrt Hwy #6129
Mill Creek WA 98012 INSURERS AFFORDING COVERAGE NAIC
INSURED INSURERA: Underwriters at Lloyd's
Greenwalk Development, LLC INSURER III; Amer ican Contractors Ind Company
12733 39th Avenue NE INSURER r'.
-INSURER D:
,Seattle WA 98125 INSURER E;
11COAf�-r-
--%.I
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAJN.
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
lqgl-;
LTR
A00'L
INSRDI
TYPE OF INSURANCE
POLICY NUM43ER
POLICY EFFECTIVE
CATE(MMIDDITY1
POUCY EXPIRATION
DATf(MM1DDfYYj
LIMITS
GENERAL LIABILITY
F-AC14 OCCUPJPPNCE
$ 1,000,000
DAMAGE TO RENTEO
_ S (120 cccurrq'Icn)
PFICMIS�
% 100,000
COMMERCIAL GENERAL LIABILITY
MED EXP (Any one person)
S 5,000
A
CLAIMS MADE F7X OCCUR
MCP 46-000OS2
3/20/2007
9/20/2008
PERSONAL & ADV INJURY
S 1,000,000
GENERAL AGGREGATE
2,000,000
AGGREGATE LIMIT APPLIES PER:
PRODUCT$ - COMPIOP AGG
2,000,000
FGEN't.
7E, POLICY F7 JT& 7 LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Eq accideni)
1,000,000
BODILY INJURY
(Per person)
A
ALL OWNED AUTOS
SCHEDULEDAUTOS
X
BODILY INJURY
(Per accident)
S
HIRED AUTOS
NON-OWNEDAUTOS
MCP 45-000052
9/20/2007
9/20/2008
X
PROPERTY DAMAGE
tPer accident)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO
$
RANY
AUTO ONLY! AGG
EXCESSIUMBRELLA LIABILITY
_IEAqH %�QURPENPE
AGGREGATE
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION
A
Waahinton Stop Gap
T- ATY� 0TH-
OW
LIM ER
E,L, EACH ACCIDENT
$ 1,000,000
EMPLOYERS' U ABILITY
ANY PPOPPIETOWPARTNERIGNPCUTIVE
OFFICERIMEMBER EXCLUDED?
KCP 46-000052
9/20/2007
9/20/2008
EL. DISEASE - EA EMPLOYFEI
S 1,000,000
E.L. DISEASE - POLICY LIMIT
I S 1,000,000
If ves, demeribt under
SOECIAL PROVISIONS below
B
OTHER WA Contractors Bond
1000,32509
7/27/2007
ContinUOUS
Vintil Cancelled $12,000
RECEIVED
DESCRIPTION OF OPERATIONSfLOCATIOPiSIVEHICLESIEXCLUSlOf4S ADDED BY ENOORSEMENTISPECIAL PROVISIONS
City of Edmonda La addod as additional insured. J U L 2008
BUILDING DFPT.
t,;t:K I 11-11.;A I t tIULUtK �Mn�r-6Ln I 1W11
(425)771-0221 SHOULD ANY OF TWE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Edmionds EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAJL
121 Sth Ave K 30 DAYS wRirrEN NOTICE TO Tmr: CERTIFICATE HOLDeR NAMED M THE LEFT, BUT
Edmonds, WA 96020 FAILURE TO 00 80 SMALL IMPOSP NO OBLIGATION Olt LIABILITY OF AMY KIND UPON THE
AUTHORIZED RFPRFSENTATIVE
H. Eric Vennes/KANE
ACORD 25 (2001/00) W A-UKU t.WKr'UF%Fk 1 I%JN I ZOO
INS025 pionot; AMS VMP Mortg9ge Solutions. Inc. (900)12.7.0554,5 Page 1 OT 2
RETURN ADDRESS:
City of Edmonds, City Clerk
121 5th Avenue North
Edmonds, WA 98020
CONFORMED COPY
200804141166 5 PGS
04/14120094:22r 1810
SNOHOMISH OUNT , ASHINGTON
COVENANT OFNOTIFICATION
AND INDEMNIFICATION/HOLD HARMLESS
Reference #: SaQE�Q I
Grantor(s): I LLIA110
�A�j)Ay-LjApf dditionalonpg._
Grantee(s): City of Edmonds
Legal Description (abbreviated): Sec_Q �S�Twn 2--j M Rng -A- EI_Qtr N W
OR
Lot Block Plat
Assessor's Tax Parcel ID#(s): (1 (2)
Assessor's Tax Parcel ][D# not yet assigned
CITY OF EDMONDS
APPROVED FOR RECORDING
BY: -&%L DATE: AGE I OF
Under the review procedures established pursuant to the State Building Code,
incorporating amendments promulgated by the City of Edmonds, and - as a
prerequisite to the issuance of a building permit for the construction of a residentiat
structure and attendant facilities, the undersigned OWNERS of property do hereby
covenant, stipulate and promise, as follows:
1. Description of Subject Property.
[ APPRO31ED FOR RECO I&
By- __q,4&DA.TE
PA G HE
; OF
This covenant of notification and
indemnification/hold harmless relates to a tract of land at the street address of
( 5 Z I s -1 C�-QIIA P L . 141- 1 -(insert street
address), Edmonds Snohomish County, Washington and legally described as:
VA On V-_ Rh P_ T k C) M C- = P_Axln� A. L LA Km
IM E -A Un LA-3 1) A I IE L-Y i t�,I G eAS-V ERLY 0 V
2. Notification and Covenant of Notification. The above referenced site
(hereinafter "subject site") lies within an area which has been identified by the City
of Edmonds as having a potential for earth subsidence or landslide. hazard. The
risks associated with development of the site have been evaluated. by technical
consultants and engineers engaged by the applicant as a part of the process to
obtain a building permit for the subject site. The results of the consultant's reports
and evaluations ofthe risks associated -with development are contained inbuilding
permit file number cP-491619117 (insert number) on file with the City of
Edmonds Building Department. Conditions, limitations, or prohibitions on
development may have been imposed in accordance with the recommendations of
the consultants in the course of permit issuance. The conditions, limitations, or
prohibitions may require ongoing maintenance on the part of any owner or lessee or
may require modifications to the structures and earth stabilization matters in order
to address future or anticipated changes in soil or other site conditions. The
statements and conditions proposed by the OWNERS' geotechnical engineer,
geologist, architect and/or structural engineer are hereby incorporated by reference
from the contents of the file as fully as if herein set forth. Any future purchaser,
lessee, lender or any other person acquiring or seeking to acquire an interest in the
property is put on notice of the existence of the content of the file and the City urges
review of its contents. The file may be reviewed during normal business hours or
copies obtained at the Building Department, City of Edmonds, 121 5th Avenue
North, Edmonds, Washington 98020.
3. Indemnification and Hold Harmless. The undersigned OWNERS
hereby waive any and all liability associated with development, stating that they
have fully informed themselves of all risks associated with development of the
property and do therefore waive and relinquish any and all causes of action against
the City of Edmonds, its officers, agents and employees arising from and out of. such
development. In addition, the OWNERS on behalf of themselves, their successors in
interest, heirs and assignees, do hereby promise to indemnify and hold harmless the
City of Edmonds, its officers, agents and employees from any loss, claim, liability or
damage of any kind or nature to persons or property either on or off the site
resulting from or out of earth subsidence or landslide hazard, arising from or out of
the issuance of any permit(s) authorizing development of the site, or occurring or
A 0 Df R R JO�'G*
PP 0
By-!� DAT
PACE OF
arising out of any false, misleading, or inaccurate information provided by the
OWNERS, their employees, or professional consultants in the course of issuance of
the building permit.
4. Insurance Requirement. In addition to any bonding which may be.
required during the course of development, the Community Services Director
has/has not (strike one) specifically required the maintenance of an insurance policy
for public liability coverage in the amount and for the time set forth below in order
to provide for the financial responsibilities established through the indemnification
and hold harmless agreement above:
5. Covenant to Touch and Concern the Land. This covenant of
.notification and indemnification/hold harmless touches and concerns the subject
tract and shall run with the land, binding, obligating and/or inuring to the benefit of
future owners,, heirs, successors. and interests or any other person or entity
acquiring an interest in property, as their interest may appear. This provision shall
not be interpreted to require a mortgagor or lender to indemnify the City except to
the extent of their loss nor to obligate such persons to maintain the insurance above
required.
1 0
APPRO ED OR R�ECWM
DA
PAGE 57 OF
-9
DONE this 9 —"A day of Ajnxl
OWNER(S
By:
By:
By
STATE OF WASHINGTON
ss:
COUNTY OF
I certify that I know or have satisfactory evidence that Ron VA %� acA
C�od \1\-1\Aw-a signed this instrument and
acknowledged it to be (his/her) free and voluntary act for the purposes mentioned in
this instrument.
13M-7
DATED this day of L1WCxy-Nb4x-- . 1 "9- .
N
NOTARY
PUBLIC
1,,�201i
L-NTEMP\BUILDING\MEADOW\COVENANT
NWrARY PUBLIC
My commission ex ires: t Q t I
� P.